NFL contends adding sideline doctors could compound concussion woes

Nov. 14, 2012
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(8) Footballâ??s head-injury epidemic. Every year, the anecdotal evidence grows more distressing while the scientific evidence grows more damning. At this point, it isnâ??t a question of whether playing tackle football -- pro football, specifically -- damages your brain. It is a question of what the NFL plans to do about it and what the impact of new information, from the pros to Pop Warner, means for the long-term future of the sport. / Paul Kitagaki Jr./The Sacramento Bee/AP

by Jarrett Bell, USA TODAY Sports

by Jarrett Bell, USA TODAY Sports

While the NFL players association continues to push for the addition of independent neurological experts on the sidelines to help diagnose head injuries, one of the league's chief physicians on the concussion front is philosophically opposed.

"Independent experts on sidelines would make (the) situation worse, unless they had a baseline exam on each player," Richard Ellenbogen, co-chair of the NFL's Head, Neck and Spine Committee, wrote in an e-mail to USA TODAY Sports on Tuesday night. "No one knows the players as well as the athletic trainers, period.

"Having said that, some teams already have neurosurgeons on the sidelines. Having a doc show up just for a game takes away from the all-important baseline exam and continuity of care. It would be like getting operated upon by a surgeon who did not see you pre-operatively. Is that safer than having someone who saw you beforehand? The baseline is all important in making an assessment if a player is OK after a hit."

Thom Mayer, medical director for the NFL Players Association, could not be reached for comment on Tuesday but previously told USA TODAY Sports that he felt the independent experts would be valuable in providing additional opinions. Mayer said the independent medical experts could be neurologists, or perhaps emergency medical services (EMS) personnel. He said his objective is to have experts on hand trained at diagnosing concussions.

Although the NFL said the team physicians and trainers properly followed concussion guidelines, the cases of Smith and Cutler have drawn considerable attention as they continued to play for an extended period after they absorbed blows to the head. They were later diagnosed with concussions.

The teams concluded that Smith and Cutler suffered concussions on subsequent plays after the big hits, and the NFL maintains that the players were removed immediately after their concussion symptoms were diagnosed.

The players union is reviewing whether guidelines were followed and has engaged in dialogue with the league this week about revising the policy.

"We are continuously working on educating all players, refs and teams about the importance of this injury," Ellenbogen wrote. "Unfortunately, although some players are very good about reporting injuries in other players and sometimes in themselves, often a player does not realize they are concussed because they have a TBI (traumatic brain injury). We are always looking for new ways to make the game safer."

In December, the league revised its policy to mandate that independent athletic trainers are stationed in the press box as observers. The trainers are authorized to call the team benches to have players examined that they suspect could have suffered a head injury.

That change in policy was prompted by the case of Cleveland Browns quarterback Colt McCoy, who played after suffering a concussion received from a blow to the head from Pittsburgh Steelers linebacker James Harrison last season. Trainers and team physicians never examined McCoy for a head injury as they never saw the hit that caused the injury while tending to another injured player on the bench.

Ellenbogen noted that through the first six weeks of the season, trainers made at least 193 calls to request exams.

"Many players were examined and removed, but not all," he wrote.

How did the trainers react in the cases of Smith and Cutler?

"Trainers in the press box and team doctors called each other about the same time in both cases," Ellenbogen said. "Doctors went over video in both cases."

Even so, the concussions were not diagnosed until later.

How could Smith and Cutler continue playing when it seemed apparent to many observers that they took hits that caused injuries?

"The physics of the hit do not always translate into a concussion," Ellenbogen wrote. "The amount of impact does not always correlate to the concussion. It is often related to angular acceleration, not linear acceleration of the hit. Need to look at player and have baseline exam and compare to that.

"Smith was concussed on second, not first hit. Cutler was OK after first hit but got new symptoms as the game progressed. And remember the problem is that with all the adrenaline, the concussion was not immediately obvious to the players. Both became symptomatic as they played further. That certainly is not uncommon for concussions to evolve. If you have seen one, you have seen one. They are all different."